Globally, the incident cases of pneumoconiosis increased 66.0% from 36,186 in 1990 to 60,055 in 2017 (Table 1). For SDI regions, the number of pneumoconiosis cases increased across the five SDI regions (Figure 1), despite a decrease in the ASIR from 1990 to 2017 (Table 1). For geographical regions, except for the three regions (central Europe, eastern Europe, and western Europe), absolute numbers of pneumoconiosis cases increased in other regions (Figure 2). As for ASIR, the most significant decrease was detected in western Europe (AAPC = -2.5; 95% CI: -2.7, -2.2). The most significant increase was detected in Australasia (AAPC = 1.4, 95% CI: 1.3, 1.5) (Table 1).
The highest ASIR observed in Taiwan (China) (1·92 per 100,000 in 2017), followed by Papua new guinea (1·68 per 100,000 in 2017) and China (1·66 per 100,000 in 2017) (Figure 3A). As for the absolute number, more than half of newly diagnosed pneumoconiosis were recorded in China in 2017 (32,205), followed by India (5160) and the USA (3324) (Supplementary Table 2).
The ASIR decreased by an average 0.6% (95% CI: 0.5%, 0.6%) per year in the same period (from 0.52 per 100,000 in 1990 to 0.28 per 100,000 in 2017) (Table 1). The Netherlands (AAPC = -6.3; 95% CI: -6.9, -5.7) and Belgium (AAPC = -6.2; 95% CI: -6.9, -5.4) reported the largest decreasing in pneumoconiosis ASIR between 1990 and 2017. In contrast, the largest increase in ASIR was observed in the New Zealand (AAPC = 2.6; 95% CI: 2.6, 2.7) (Figure 3B, Supplementary Table 2).
The proportions of pneumoconiosis caused by specific etiologies at the global and regional level in 1990 and 2017 are presented (Figure 4). Globally, approximately 40% of pneumoconiosis was caused by crystalline silica, followed by coal dust, other causes, and asbestos. The proportions significantly changed in some regions over time. For instance, in the global, the proportion of asbestosis increased from 11.98% in 1990 to 15.65% in 2017, while the proportion of coal workers pneumoconiosis decreased from 27.13% to 25.11% during the same period. In the Australia, the proportion of asbestosis increased from 46.12% in 1990 to 77.85% in 2017, while the proportion of coal workers pneumoconiosis decreased from 27.13% to 7.98% during the same period. Similar result was observed in the high-income north America.
Globally, 39.46% of total pneumoconiosis (23,695) was ascribed to silicosis in 2017 (Figure 4; Table 1). For SDI regions, silicosis cases increased across all five regions, while the ASIR decreased in all SDI regions (Figure 1; Supplementary Table 1). For geographical regions, five regions (central Europe, eastern Europe, high-income Asia Pacific, western Europe, and Caribbean) reported a decreasing silicosis cases (Figure 2; Supplementary Table 1). In parallel, the ASIR of silicosis displayed a minor increasing trend in southeast Asia (AAPC = 0.4; 95% CI: 0.2, 0.5), north Africa and Middle East (AAPC = 0.2; 95% CI: 0.1, 0.3), and western sub-Saharan Africa (AAPC = 0.3; 95% CI: 0.2, 0.4), AAPC of silicosis decreased in other regions (Supplementary Table 1). The highest ASIR observed in China (Supplementary Table 2). From 1990 to 2017, the ASIR of silicosis displayed a decreasing trend (AAPC = -0.8; 95% CI -0.9, -0.7). The highest AAPC was found in the Singapore (AAPC = 2.2; 95% CI: 1.8, 2.6), followed by the New Zealand and the American Samoa (Supplementary Table 2).
In 2017, asbestosis precipitated nearly 15.65% (9397) of the total number of pneumoconiosis cases (Figure 4; Table 1). For SDI regions, the increasing trend in asbestosis were observed in High SDI regions (AAPC = 1.6; 95% CI 1.4, 1.7) and Low-middle SDI regions (AAPC = 0.2; 95% CI: 0.1, 0.3) (Supplementary Table 1). For geographical regions, except for the two regions (eastern Europe and western sub-Saharan Africa), absolute numbers of pneumoconiosis cases increased in other regions. The greatest increase was found in Australasia (AAPC = 3.5; 95% CI: 3.2, 3.7) (Supplementary Table 1).Globally, the ASIR of asbestosis displayed an increasing trend from 1990 to 2017, with the AAPC of 0.6 (95% CI: 0.5, 0.6) (Table 1), despite the incidence of pneumoconiosis due to asbestosis was under 0.10 per 100,000 in 2017 in most countries. The highest rate was observed in south Africa (0.50 per 100,000), followed by Swaziland and the United States. At the national level, the highest increase in asbestosis ASIR was observed in the Australia (AAPC = 3.5; 95% CI: 3.3, 3.8), followed by the New Zealand and Spain (Supplementary Table 2).
In 2017, coal workers’ pneumoconiosis accounted for 25.11% (15,080) of total pneumoconiosis cases, despite only 78 countries and territories reported coal workers’ pneumoconiosis cases (Figure 4; Table 1). The ASIR of coal workers’ pneumoconiosis decreased in all SDI regions over time (Supplementary Table 1). For geographical regions, only four regions (Oceania, western sub-Saharan Africa, north Africa and Middle East, and southeast Asia) reported a increasing ASIR of coal workers’ pneumoconiosis, the greatest increase was found in Oceania (AAPC = 1.0; 95% CI: 1.0, 1.1), AAPC of coal workers’ pneumoconiosis decreased in other regions (Supplementary Table 1). The highest absolute numbers observed in China (10,287) (Supplementary Table 2). From 1990 to 2017, the ASIR of coal workers’ pneumoconiosis displayed a decreasing trend (AAPC = -0.9; 95% CI: -0.9, -0.8) (Table 1). With respect to countries, the relatively higher ASIRs were observed in Taiwan (China) (0.76 per 100,000 in 2017), followed by China (0.53 per 100,000 in 2017) and North Korea (0.48 per 100,000 in 2017), with the highest increase in ASIR observed in New Zealand (AAPC = 2.5; 95% CI: 2.2, 2.8), followed by Taiwan (China) (AAPC = 1.7; 95% CI: 1.5, 1.9) and Montenegro (AAPC = 1.6; 95% CI: 1.3, 2.0) (Supplementary Table 2).
In 2017, other pneumoconiosis accounted for 19.79% (11,883) of total pneumoconiosis cases (Figure 4; Table 1). The ASIR of other pneumoconiosis remained stable in High SDI regions, decreased in other SDI regions (Supplementary Table 1). For geographical regions, only five regions (high-income north America, southeast Asia, Oceania, Andean Latin America, and north Africa and Middle East) reported a increasing ASIR of other pneumoconiosis, the greatest increase was found in high-income north America (AAPC = 0.8; 95% CI: 0.6, 0.9), AAPC of other pneumoconiosis decreased in other regions (Supplementary Table 1). The global ASIR of other pneumoconiosis decreased by an average 0.5% (Table 1) per year from 1990 to 2017. The highest ASIR was observed in Taiwan (China) (0.76 per 100,000 in 2017), followed by Papua New Guinea (0.71 per 100,000 in 2017), with the highest increase in ASIR observed in Denmark (AAPC = 2.5; 95% CI: 1.7, 3.4) (Supplementary Table 2).
The GBD regions of east Asia, Oceania, southern sub-Saharan Africa, central Europe, central Latin America, high-income Asia Pacific, and high-income North America had higher ASIRs due to pneumoconiosis than expected based on their SDI. Regions with better-than-expected pneumoconiosis ASIRs included Caribbean, western Europe, western sub-Saharan Africa, central Asia, Andean Latin America, north Africa and Middle East, and southeast Asia (Figure 5). Further evaluation of the relationship between ASIR and SDI in different categories of pneumoconiosis, we observed that east Asia, Oceania, southern Latin America, central Europe, and high-income Asia Pacific had higher ASIRs due to silicosis than expected based on their SDI; southern sub-Saharan Africa, high-income North America, Australasia, Oceania, central sub-Saharan Africa, and eastern sub-Saharan Africa had higher ASIRs due to asbestosis than expected based on their SDI; east Asia, and central Europe had higher ASIRs due to coal workers’ pneumoconiosis than expected based on their SDI; oceania, central Latin America, east Asia, central Europe, eastern Europe, and high-income Asia Pacific had higher ASIRs due to other pneumoconiosis than expected based on their SDI (Supplementary Figure 2).
As shown in Figure 6, a significant negative association was found between AAPCs and SDIs in 2017 when the SDI above 0.7. In contrast, a SDI was limited to below 0.7, the association disappeared. Similar relationships were observed when we further evaluated the association between AAPCs and SDIs in silicosis, coal workers’ pneumoconiosis, and other pneumoconiosis, while the association between AAPCs and SDIs in asbestosis is not significant (Supplementary Figure 3).